Changes in ownership trends and the migration of care away from high-acuity settings are indicative of a business environment that can be highly rewarding for ASCs — if leaders respond appropriately.
Bill Wilder, marketing director — U.S. marketing, joints, outpatient, with DePuy Synthes', a Johnson & Johnson company, discusses how ASC leaders can ensure their organization thrives into the future.
Mr. Wilder is a featured speaker at Becker's ASC Review 26TH Annual Meeting:
The Business and Operations of ASCs, Oct. 24-26 in Chicago. Click here to learn more about the conference.
Question: What are the most important trends you're seeing in the ASC field today?
Bill Wilder: There are two primary trends that have dominated the ASC landscape the last 2 to 3 years. The first is the migration of higher acuity cases to a lower acuity setting. This volume shift has been led by orthopedics — mainly total joints and spine as well. The evolution is also affecting other specialties. For example, there are GYN, general, plastics and cardio cases also shifting — albeit more slowly. There are multiple forces or stakeholders driving this high acuity case movement — physicians, payers, patients and hospitals. For the properly selected patient, the ASC setting is the Quadruple Aim sweet spot. Meaning, outcomes are as good if not improved, costs are lower, patients are delighted, and physician/staff satisfaction enhanced. That's a win-win for everybody.
The second dominant trend I see is the proliferation of equity movement — or ownership changes — in the ASC setting. More than half of the Medicare-certified ASCs are still physician owned, but that trend appears to be changing. Specifically, physicians seem to be more open to joint venture relationships with hospitals and/or surgery center management companies. The shift toward hospital-physician ASC partnerships appears to be driven by the industry's challenging reimbursement and regulatory environment. Partnering with an ASC management organization can bring operational expertise in running the facility as well as the potential to access favorable managed care rates. In addition to equity relationships with hospitals and surgery center management companies, there are markets where competitive physician groups are merging — as partners in an ASC setting. Finally, private equity firms are also partnering with physicians in select markets.
Q: What are the top one or two solutions to the big challenges you're seeing for ASCs today?
BW: There are many challenges ASCs face today; I will address two of the more prominent ones and potential remedies. First, securing the right managed care contract that recognizes the value derived from migration of procedures from inpatient to outpatient is paramount. This is especially true for newer procedures, total joint replacement for example. In many instances during the commercial payer negotiation process, the payer is looking for the provider to take the lead. Payers are seeking justification; they're seeking data to substantiate a requested rate. Leading with evidence is increasingly important for surgery centers. A data collection platform — to track/measure outcomes and patient experience — may be a valuable tool for ASCs. ASCs are already doing more data reporting and analysis. If done well, evidence is generated that could be shared with managed care companies. Substantiating a statement or ask with evidence lends itself to a favorable result.
A second challenge facing ASCs today is providing patients with opioid sparing surgical options. Market dynamics and patient inquiries are urging ASC customers to place a higher value on multi-modal pain management strategies to optimize the patient experience. ASC administrators, CEOs and orthopedic surgeons are moving quickly to adopt nonopioid alternatives to support their orthopedic/soft tissue procedures. EXPAREL® (bupivacaine liposome injectable suspension), used in conjunction with a multimodal approach, is an option many ASCs are adopting.
Q: Where is the best opportunity for ASCs to thrive in the future? What do they need to do today to set a solid foundation for success?
BW: Thriving in the future may require ASCs to think differently, think bigger, think beyond the acute setting, beyond the four walls. Many ASCs are leveraging technology platforms to effectively optimize, customize and enhance the patient experience — through the entire episode; inclusive of post-acute space. Digital care platforms that deliver personalized care plans can influence experience, cost and outcomes.